Ant bite artifacts in a case of hanging

Artifacts produced by postmortem animal scavenging are commonly encountered at autopsy. Knowledge of the pattern of artifacts produced by postmortem animal scavenging is essential for the correct interpretation of the autopsy finding. In household deaths, such artifacts are usually caused by domestic animals and by small insects such as flies, ants, beetles, etc. Ants are one of the early scavengers which feed on the dead bodies. The artifacts produced by the postmortem ant activity are usually superficial and non-bleeding type. Rarely, in the congested body regions and areas of marked hypostasis, postmortem bleeding artifacts due to ant bites are possible. In the reported case of hanging, such postmortem bleeding artifacts were present over both the legs, predominantly over the left leg. Typical ant bite lesions in the form of superficial excoriations were also present over the peri-ligature area, over and around both nipples and over the lower part of the abdomen. Morphologically, postmortem bleeding artifacts produced by ant bites exhibit four patterns: droplet pattern, stripe pattern, pool pattern, and mixed pattern. In this case, a mixed pattern (droplet pattern and stripe pattern) of postmortem bleeding artifacts was observed. The presence of postmortem bleeding artifacts over the lower limbs was attributed to the pooling of the blood due to suspension of the body, followed by passive escape of blood due to ant bites. The possibility of such artifacts produced by ant bites should be considered when the origin of the lesion is unclear.

Medical termination of pregnancy: A global perspective and Indian scenario

Abortion has always been a vital issue in reproductive and legal medicine. Globally, medical termination of pregnancy (MTP) is allowed primarily on six grounds: (1) to save the life of a woman, (2) risk to the physical and mental health of a woman, (3) pregnancy due to rape or incest, (4) risk of a child being born with a serious fetal anomaly, (5) socio-economic reasons, (6) a woman's request. Most countries have standard legal abortion policies, yet there remains disparity with respect to prohibition, gestational age limit, specific grounds, etc. Abortion laws are constantly changing globally based on regional social and economic viewpoints. Recently, some countries have liberalised their abortion laws, while a few have further restricted theirs. While some countries still completely prohibit MTP. Like some others, India amended its MTP law in 2021. We consider the medico-legal and ethical issues and examine existing MTP laws both globally and as generally applied in India.

An unusual case of high-voltage electrocution of a truck driver due to inadvertent contact of the truck with an overhead wire

Electrocution deaths are mostly accidental. However, reconstruction of events in unusual electrocution death is challenging. This article reports an accidental death due to electrocution in a highly unusual circumstance, in which a truck driver reversing his vehicle was electrocuted when his truck inadvertently touched an overhead high-voltage wire. The electric injury marks were present over the sole of the right foot. The scene investigation revealed that the high-voltage wire was loose and was below the level of the prescribed height. The truck was passing over an elevated area made up of dirt and stone. The interior of the cabin of the truck revealed a few non-insulated metallic areas over the floor of the truck, between the accelerator and the brake, which were attributed as the sources of entry of electricity into the body. The electric injury marks were different than those usually seen in high-voltage electrocution as there was an intermediate object (truck) involved, and the contact period between the truck and the electric wire was minimal. This fatality was attributed to the non-proper insulation of the interior of the truck, the negligent driving of the truck driver over the elevated surface, and the loose high-voltage wire without proper maintenance.

ChatGPT in medical research: challenging time ahead

Since its launch, ChatGPT, an artificial intelligence-powered language model tool, has generated significant attention in research writing. The use of ChatGPT in medical research can be a double-edged sword. ChatGPT can expedite the research writing process by assisting with hypothesis formulation, literature review, data analysis and manuscript writing. On the other hand, using ChatGPT raises concerns regarding the originality and authenticity of content, the precision and potential bias of the tool's output, and the potential legal issues associated with privacy, confidentiality and plagiarism. The article also calls for adherence to stringent citation guidelines and the development of regulations promoting the responsible application of AI. Despite the revolutionary capabilities of ChatGPT, the article highlights its inability to replicate human thought and the difficulties in maintaining the integrity and reliability of ChatGPT-enabled research, particularly in complex fields such as medicine and law. AI tools can be used as supplementary aids rather than primary sources of analysis in medical research writing.

Fatal exsanguination following complete transection of femoral vessels due to angle grinder injury in an industrial accident

Angle grinders are one of the most dangerous and frequently used tools in industrial settings. Angle grinder injuries range from superficial cuts to deep penetrating injuries with underlying fracture-dislocation and vascular trauma. The injuries caused by angle grinders mostly involve the head, face, or upper limbs, while the lower limb is an unusual site. The high-speed rotating disc of the angle grinders does not respect anatomical boundaries or structures; therefore, the injuries caused may be disfiguring, permanently incapacitating, or even fatal. We report a fatal case of an angle grinder injury to the lower limb. The victim sustained a sharp cut over the left thigh while woodworking in an industrial setup. The rotating disc of an angle grinder had transected the skin, subcutaneous fat and muscles, and both the femoral vessels of the left side, which led to fatal exsanguination within 10 min of the incident.

Focal Cortical Dysplasia with hippocampal sclerosis

Focal Cortical Dysplasia (FCD) is a group of focal developmental malformations of the cerebral cortex cytoarchitecture. FCD usually manifests as medically intractable epilepsy, especially in young children. Live patients are diagnosed by radiological examination such as magnetic resonance imaging (MRI), fluorodeoxyglucose positron emission tomography (FDG PET), magnetoencephalography (MEG), diffusion-tensor imaging (DTI), and intracranial electroencephalogram (EEG). While some cases can be missed by radiological examination, they are usually diagnosed on the histopathological examination of the surgically removed specimens of medically intractable epilepsy patients. We report a case of a young girl with cerebral palsy, mental retardation, and seizure disorder who died in her sleep. The deceased was diagnosed with FCD type III with hippocampal sclerosis on histopathological examination at autopsy. H & E stain and NeuN immunohistochemistry neuronal cell marker were used to demonstrate the findings of FCD.

Age Estimation in Sportspersons From the Epiphyseal Fusion Around Wrist, Elbow, and Pelvic Joints

Background Age estimation of an individual is an integral part of medicolegal work. Out of many scenarios for which age estimation is performed, competitive sports is the one emerging field where experts are consulted for providing accurate age of the athlete. Owing to the chances of deliberately increasing (padding) or decreasing (shaving) the age of the athlete for his own advantage, accurate age estimation is crucial. The Sports Authority of India (SAI) mandates age verification from experts prior to participation in sports events in various age group categories. One of the widely used methods of age estimation in athletes is the radiological examination of the ossification centers of bones. Methodology The study was performed on 134 athletes (72 males and 62 females) with an age range of 12-18 years old with due permission from the Sports Authority of India (SAI) for this study. These participants compete at state, national, and international levels in squash, handball, swimming, cricket, and judo in under-14, under-16, and under-19 age categories. X-rays of the wrists, elbows, and pelvis were analyzed using the Schmeling five-stage method for the fusion of ossification centers. Results A greater degree of correlation between the fusion stages of all regions of interest and chronological age was observed in males than in females. The highest correlation in both sexes is observed between the fusion score of the head of the radius and the age (R = 0.814 for males and R = 0.647 for females). The lowest correlation for both males and females is seen between the fusion score of the lateral epicondyle of the humerus and age (R = 0.754 for males and R = 0.441 for females). Multiple linear regression models showed a standard error of estimate (SEE) of 1.093 years for the elbow joint, 1.147 years for the wrist joint, 1.039 years for the pelvis joint, and 1.030 years for all three joints. Conclusion Regression models generated for estimating the age of sportspersons from the ossification centers of the elbow, wrist, and pelvis in the present study can be applied for the age estimation of individuals aged between 12 and 18 years. Future population-specific studies on the age estimation of sportspersons with greater sample sizes are necessary to validate the findings of the present study.

Accidental Blast Injuries While Making Indigenous Explosive Chemical Mixture: A Report of Two Incidents

Apart from terrorist and military bombing, accidental blast injuries are the major source of morbidity and mortality in explosion occurrences. In civilian scenarios, it can happen when unskilled individuals handle explosive materials carelessly, often avoiding legal restrictions. We report two incidents of an accidental explosion in which three victims got injured during the mixing of explosive chemicals which are used in an improvised pipe gun to scare away the animals on the farm. In both incidents, the victims were mixing Gandhak (sulfur) and Potash to make an indigenous fire cracker-type explosive mixture. The victims suffered classical low-order explosion injuries. The chemical reaction between the chemicals, the treatment course of all three victims, and medico-legal implications are also discussed in the article.

Unusual subcutaneous emphysema extending to the limbs following blunt chest injury

Subcutaneous emphysema can be traumatic, infectious, iatrogenic, or spontaneous. Traumatic subcutaneous emphysema of the upper limb is not infrequent following trauma to that limb. However, the subcutaneous emphysema of the limbs following trauma to a site other than the limb is seldom reported. A 45-year-old male was referred from a private hospital to a tertiary care hospital with right-sided multiple rib fractures and pneumothorax following chest injury. The patient was having acidotic breathing on examination, and crepitus was present over the bilateral chest and bilateral upper and lower limbs, suggesting subcutaneous emphysema. Right and left intercostal drainage tubes were inserted at our hospital. The patient died in the emergency after a few hours of treatment. The X-ray performed at the autopsy revealed extensive bilateral upper and lower limb subcutaneous emphysema. The deceased had multiple rib fractures over the right side with fractured ends of the two ribs piercing the pleural cavity, causing tears in the lung parenchyma. The cause of death was attributed to the chest injury and its sequelae. Such rapidly expanding subcutaneous emphysema can be a sign of underlying severe chest injury. Prompt insertion of the intercostal drainage tube could be the lifesaving procedure in such cases.

Accidental Deaths Due to Toxic Industrial Cyanide Inhalation: An Autopsy Case Report

Autopsies of accidental deaths in industrial scenarios have always been a challenging job for a forensic pathologist. Industries that employ chemical agents pose a unique risk, especially when safety protocols are ignored. Exposure to cyanide salts creates an additional risk since death may occur quickly. We present one such incident of the accidental deaths of three industrial workers, which could have been prevented if proper safety measures had been followed. Four workers fell unconscious while cleaning the electroplating chamber of the handicraft industry. Three were declared dead on arrival at the emergency department, while one survived. Autopsy of all three victims showed similar findings of pink-colored post-mortem staining and multiple petechial hemorrhages over the heart and lungs. After histopathological and chemical analysis, the cause of death was opined to be due to complications of cyanide poisoning. In accidental industrial deaths, the forensic pathologist should consider the possibility of death due to toxic chemicals, such as cyanide, used in the manufacturing process. The industrial personnel should be educated about the risks involved, and proper use of safety equipment should be encouraged to avoid such hazardous outcomes. Additionally, the people employed in the autopsy of the deaths related to chemical disasters should ensure their personal safety and preventive measures.

Age-related changes in the hyoid bone: An autopsy-based radiological analysis

Forensic age estimation is a crucial aspect of the biological profile of unidentified cadavers. The utility of age-related changes of hyoid bone fusion in forensic age estimation has not been explored much in the past. These age-related changes can be visualised in both the living and the dead using conventional radiography. These changes can assist medico-legal professionals and forensic anthropologists in the identification of unknown deceased, especially when the cadaver is mutilated or charred or when the other well-established indicators of skeletal and dental maturity are absent. The aims of this study were to evaluate age-related changes in the hyoid bone and to ascertain whether these changes may be utilised for age estimation in forensic examinations. The hyoid bone was carefully dissected using a standard procedure from 75 cadavers during post-mortem examination. The hyoid bone was radiographed, and the bone was replaced in the body cavity before the post-mortem examination was completed. Hyoid bone fusion was studied by using a standard grading method. Spearman's correlation coefficient was calculated between the fusion scores and chronological age to assess their relationship. Box and whisker plots of fusion stage-wise age distribution were constructed to demonstrate the gradual linear relationship between hyoid bone fusion and the chronological age of the study participants. The present study concludes that hyoid bone fusion is an indicator of the chronological age of an individual and can be used in conjunction with other methods of age estimation such as the skeletal and dental age.

Age related changes in thyroid and cricoid cartilages: An autopsy based radiological analysis

Forensic age estimation is an invaluable aspect of human identification. Out of these many means of age estimation, few regions with untapped potential for assistance in forensic age estimation are the age-related changes in the laryngeal cartilages. As the age advances, the thyroid and cricoid cartilages undergo gradual calcification in an individual. These age-related changes can be visualized in both the living and the dead using conventional radiography and can be objectively assessed. The objective of the present study was to evaluate the age-related changes in the laryngeal cartilages and the results may be utilized for age estimation in forensic examinations. The laryngeal cartilages were carefully dissected using standard procedures from 75 cadavers of age ranging from 17 to 65 years, during the post-mortem examination. The laryngeal cartilages were radiographed and replaced in the body cavity before culminating the post-mortem examination. The calcification of both cartilages was studied by using the standard grading method. Calcification scores of individual regions of both the laryngeal cartilages show a statistically significant positive correlation with chronological age (P < 0.05). Regression models derived from the degree of calcification of thyroid and cricoid cartilages showed standard error of estimates that ranged between 9.90 and 11.07 years. Considering the standard error of estimates of the regression analysis, the present study concludes that these regression models can be used in adjunct with other methods of age estimation such as the skeletal and dental age or when such methods are not viable as in cases of charred or mutilated remains.

Traumatic inguinal hernia: An uncommonly reported entity

Traumatic abdominal wall herniation, especially of the groin region, is a rare condition and typically results from a high-energy trauma to the abdominal wall. We report a fatal case of a road-traffic collision involving a young male motorcyclist who collided with a speeding lorry. The victim sustained multiple injuries over the chest and abdomen, with traumatic inguinal herniation causing gross distension of the scrotum. At autopsy, multiple lacerations of thoracic and abdominal organs were seen, along with traumatic disruption of the right inguinal canal. The contused terminal ileum was present in the scrotal sac. A literature search has revealed a limited number of reported cases of gross inguinal herniation following thoracoabdominal trauma. In cases of high-energy trauma to the thoraco-abdominal region with unilateral or bilateral distension of the scrotum, the possibility of herniation of the abdominal contents into the scrotal sac should be considered by the forensic pathologist.